Interdisciplinary ViewInterdisciplinary View

Cases of ill-healthCases of ill-health

Dr. Craig JacksonSenior Lecturer in Health Psychology

Faculty of HealthBCU

www.hcc.bcu.ac.uk/craigjacksonwww.hcc.bcu.ac.uk/craigjackson

PathogenPathogen DiseaseDisease (pathology)(pathology)

ModifiersModifiersLifestyleLifestyleIndividual susceptibilityIndividual susceptibility

Traditional model of Disease DevelopmentTraditional model of Disease Development

HazardHazard

Psychosocial FactorsPsychosocial FactorsAttitudesAttitudesBehaviourBehaviourQuality of LifeQuality of Life

Illness Illness (well-being)(well-being)

Biopsychosocial model of IllnessBiopsychosocial model of Illness

Recap Sociology of ill healthRecap Sociology of ill health

Recap Psychology of ill healthRecap Psychology of ill health

Recap Physiology of ill healthRecap Physiology of ill health

Case #1 – Mrs BurroughsCase #1 – Mrs Burroughs

•30-year-old married woman •married 6 years•secretary in company

•hospitalized about one month ago for pneumonia •responded well to erythromycin •discharged after 5 days•completed a 14-day course of antibiotics

•within 2 weeks of discharge, she noted:increasing shortness of breath & low-grade feversimilar to what she had before she was hospitalized

Case #1 – Mrs BurroughsCase #1 – Mrs Burroughs

• history of asthma as a child (not had problems since)• no history of heart disease, diabetes, allergies, lung disease in her• family, or other ill family members who are currently ill• denies any history of blood transfusions or sex outside of marriage • has a 4-year-old son• not taking any medications except for paracetamol prn

On interview with attending physician;possible recurrent pneumonia shortness of breath chest pain fever slight hypertensionsome skin rash

Case #1 – Mrs BurroughsCase #1 – Mrs Burroughs

AVENUES OF INVESTIAGTION – COMMUNITY EXPOSURES

• Home exposures• General• Consumer products

smokingpesticidesair freshenerssoft furnishings

• Hobbies• Building materials• Heating system• Take-home toxins

Case #1 – Mrs BurroughsCase #1 – Mrs Burroughs

AVENUES OF INVESTIAGTION – OCCUPATIONAL EXPOSURES

• Other workers ill?

• Hazardous substancesChemicalBiological

• Other HazardsPsychosocialPhysicalErgonomic

Case #1 – Mrs BurroughsCase #1 – Mrs Burroughs

Symptoms

PSYCHOLOGICAL ISSUES?

PHYSIOLOGICAL ISSUES?

SOCIOLOGICAL ISSUES?

Case Summary of a Chronic Patient #2Case Summary of a Chronic Patient #2

Date Symptoms Referral

1985 (16)1985 (16) AnorexiaAnorexia Secure unit teenagersSecure unit teenagers

1986 (17)1986 (17) Suicide attemptSuicide attempt Secure unit teenagersSecure unit teenagers

1986 (17)1986 (17) Self-harmSelf-harm Secure unitSecure unit CAMHS CAMHS (A levels)(A levels) PsychiatryPsychiatry

1987-91987-9 Self-harm. AnorexiaSelf-harm. Anorexia UMCUMC (18-20)(18-20) (university)(university)

19901990 Working as au pairWorking as au pair GP monitoring & anti-depressantsGP monitoring & anti-depressants (21)(21) (left university)(left university)

19931993 Self-harmSelf-harm Secure unit admissionSecure unit admission(24)(24) (joined commune)(joined commune) ECTECT

Female. Abused by father from 6 to 15. Moved to boarding school, then to grandparents

Insomnia - Feeling worthless – Guilt - Recurrent morbid thought - Bleak views - Self harm – Suicide Ideation

Scholastically bright. University. Dropped out. Tried own business. Business failed.

Case Summary of a Chronic Patient #3Case Summary of a Chronic Patient #3

Date Symptoms Referral

1985 (17)1985 (17) Pervasive low moodPervasive low mood GP monitorsGP monitors

1986 (18)1986 (18) Suicide attemptSuicide attempt Child PsychiatryChild Psychiatry

1986 (18)1986 (18) Self-harmSelf-harm PsychiatryPsychiatry

1987 (19)1987 (19) Anorexia. Self-harm Anorexia. Self-harm Psychiatry – CPNPsychiatry – CPN

1988 (20)1988 (20) Suicide attemptSuicide attempt Psychiatry – CPNPsychiatry – CPN(failed romance)(failed romance)

1989 (21)1989 (21) Suicide attemptSuicide attempt Psychiatry – CPNPsychiatry – CPN(failed romance)(failed romance)

1990 (22)1990 (22) Fertility worriesFertility worries Psychiatry – CPN – fertility counsellingPsychiatry – CPN – fertility counselling

1990 (22) 1990 (22) Working in officeWorking in office GP monitoring & anti-depressantsGP monitoring & anti-depressants

1992 (24) 1992 (24) Self-harmSelf-harm MH unit (open door policy) CPNMH unit (open door policy) CPN

1996 (26) 1996 (26) Chronic FatigueChronic Fatigue MH unit (open door policy) CPNMH unit (open door policy) CPN

1998 (28) 1998 (28) FibromyalgiaFibromyalgia MH unit (open door policy) CPNMH unit (open door policy) CPN

“High EffortLow Reward”

“High DemandLow Control”

2x Substance abuse

2-3x Injuries

2-3x Infections

3x Back pain

5x Certain cancers

2-3x Conflicts

2-3xMental health problems

3xCardiovascular problems

Potential Health RisksPotential Health Risks

Multivariate Symptoms and Effects

Shain & Kramer 2004Shain & Kramer 2004

Summary of ill-health processesSummary of ill-health processes